Provider Demographics
NPI:1255839056
Name:RABINOVICH, MARTIN HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:HENRY
Last Name:RABINOVICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ASHFORD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-3108
Mailing Address - Country:US
Mailing Address - Phone:732-824-3794
Mailing Address - Fax:
Practice Address - Street 1:28 UNION AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3647
Practice Address - Country:US
Practice Address - Phone:732-775-1492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI027016001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics